Endodontics

What it is, briefly

Inside every tooth there is soft tissue — the pulp — carrying the blood vessels and nerves. When deep decay, a fracture or a blow reaches it, that tissue becomes inflamed or dies. This is what causes the characteristic pain, and what eventually leads to infection at the root.

Root canal treatment means cleaning the inside of the tooth, disinfecting it and sealing it. The pain stops, the infection resolves and the tooth stays in the mouth, with its root and its function.

The alternative is to remove it and then consider an implant or a bridge. So the important question is not whether root canal treatment hurts — with anaesthetic, it does not — but whether the tooth can be saved.

Can the tooth be saved?

This is the question that brings most patients here, often after being told elsewhere that it cannot.

The answer depends on how much sound tooth remains, the state of the surrounding bone, and whether the root is fractured. Not on the size of the lesion: an extensive infection at the root can resolve, and teeth that look beyond saving often are not.

If you have arrived here with an extraction already advised, it is worth reading how a second opinion works. The approach here is conservative: your own tooth, wherever possible. No implant reproduces the proprioception of a natural root, or the way it distributes the forces of biting. An implant is a good solution once the tooth is gone; it is not an upgrade on keeping it.

How the work is done here

The canals inside a tooth are tenths of a millimetre across, they curve, and they often branch. The naked eye cannot make them out.

Operating microscope. Magnification and dedicated lighting reveal what would otherwise only be guessed at: accessory canals, cracks, remnants of previous treatment. It is what makes it possible to work precisely and remove only the tissue that must go.

CBCT 3D. Cone beam computed tomography gives three-dimensional images of the tooth and the bone around it. It shows fractures, resorptions and infections that a conventional X-ray misses. When it is indicated and not used, information that would change the diagnosis is lost.

Together, these are what separate treatment carried out with judgement from treatment carried out blind.

Regenerative endodontics

For decades, treating a tooth with a dead nerve meant cleaning it and filling it with an inert material, accepting that the tissue was gone for good.

Dr. Gaviño’s research is precisely about this: applying plasma rich in growth factors (PRGF) so that the tissue inside the tooth regenerates rather than being replaced. His work, published in international endodontic journals, documents cases followed for up to six years.

Until recently these techniques were reserved for young teeth whose roots had not finished forming. Part of his contribution has been showing that adult teeth also retain regenerative capacity.

Not every case is a candidate, and it is not offered as a universal alternative. But it is one more option on the table, and few practices have it.

If you have already had a root canal and it still bothers you

Treatment can fail over time: a canal was never located, the seal has leaked, or there is a fracture.

In many cases retreatment is possible: redoing the work, finding what was left untreated and sealing it again. Where that is not viable, apical surgery treats the tip of the root from outside without removing the tooth.

A treated tooth that still hurts does not automatically mean extraction. It is worth having someone look at it with a microscope and CBCT before deciding.